Prescription charges - increasing amount of people getting fines/penalties

Hi,

I’m not sure if this is relevant to here (apologies if not) as it’s maybe more debt than welfare rights. I cover both and have noticed in the past couple of weeks an increase in people getting hit with fines and penalties for ticking the ‘income related box’ on dentist and prescription charges without realising they are on CB ESA (or only got an IR amount not an actual entitlement)

Just got told by the NHS business service authority that they have gone from doing 4000 checks a week to 16000. Which makes sense as to why I keep seeing it

Anyone come across this and had any successes in challenging (obviously presuming there are reasonable grounds)?

I also got told that the prescription service has no right to appeal the penalties (whereas the dentist side of the service does). Anyone know if this is true, no right of appeal?

Ta

Not quite to the point of your query but I have noticed that this issue is often one that highlights that people are missing out on SDPs/EDPs after being migrated from IB to CBESA with no IRESA assessment having been carried out. When this is the case, once you have completed the IRESA backdating the NHS charges will be waived.

Thanks for the heads-up though, will keep an eye on whether we see a similar spike although our service is benefits only and so clients with charges will usually go elsewhere.

Hi Sam. Yep I have spotted that previously. Thanks for the reminder to check on this issue when these crop up.

We had a spate of these last year, several of whom successfully challenged the penalty.  They were mostly people on CESA who would have been entitled to exemption from NHS charges on low income grounds, had they applied for this.

Thanks Ruth, that’s useful to know. Do you happen to recall if they were successful in appealing the prescription penalties? Or was it only dental charges? Just as I got told there was absolutely no right of appeal on the prescription charges which I am double checking. I did enquire on the possibility of challenging based on the person being potentially eligible for low income exemption but was told there is no way this would apply retroactively, interesting to hear the people you worked with had some luck on that front.

This is tied in very closely to the problem of inaccurate ESA assessments - https://www.rightsnet.org.uk/forums/viewthread/5928/

I have had some cases in which the NHS charge/penalty has been dropped (one because it ‘could not be proved one way or the other’ what form of ESA the person got), others which are still on ‘hold’ as NHSBS awaits details which will show whether or not the claimant is entitled to IRESA.

Correct details are proving hard to obtain from DWP, as either they stick to their manifestly inaccurate assessments even when shown that entitlement to premiums has been missed, or they just don’t reply.

I have written to NHS Business Services to point out the flaws in the DWP letters and I am trying to get a policy discussion going about this. The letters are so confusing that nobody without full training in ESA could possibly understand them, and even then some are so bizarre that it takes a while…

The problem seems to be that the NHBS relies on DWP assessments of entitlement, and until DWP addresses the serious problems with those assessments, this farrago will carry on.

and i anticipate that this will be even more of a problem for those on UC

http://www.nhs.uk/NHSEngland/Healthcosts/Pages/universal-credit.aspx#criteria

is mud like ..... at least with IS & similar it was all clear one way or the other.

See also https://www.rightsnet.org.uk/forums/viewthread/10053.

I think this is what happens when people kick off about car parking costs at hospitals and the differences in prescriptions between England, Wales and Scotland. The NHS needs an income from somewhere!

There are also issues where the exemption depends on annual income below the CTC/WTC £15,276 threshold. That figure does not appear on TC decision notices and is communicated to NHS BSA electronically so there is no way of checking the fig used by BSA is correct / up to date following the relevant end of tax year entitlement (particulalrly where claimant may have had an award for part year only of two entitlements during the year due to couple then single claims etc.

BSA simply don’t understand the TC process!

In answer to the query in #4, all the successful challenges related to dental charges.  I suggest that your clients who qualify for a charge exemption:
1) make an immediate application for an exemption certificate
2) challenge the imposition of a penalty, however incurred.

There used to be an A5 leaflet produced by NHSBSA which explained how NHS charge penalties could be challenged.  This disappeared from their website some time ago.

From what clients tell us, there appears to be an element of collusion between the patient and the dentist relating to fee waiver, with patients signing blank forms.  Perhaps the dentist is encouraging their patient to seek treatment.

I also have it on good authority that most prescription charge fraud (in terms of the amount) is perpetrated by pharmacists eg by billing for prescribed items that are not dispensed, and by reissuing medicines returned to the pharmacy.

I find the last paragraph of that entirely credible. The NHS however does not need stories about pharmacist fraud and there has been pressure to not let the issue gather a head of steam because of course the spread of pharmacies into supermarkets etc. starts to impact private capital etc. as well as the NHS.

A friend of mine sent me this sympathetic article the other day;  as it turns out, her son has now been sent repeated penalties for claiming prescriptions on the basis of Contributory ESA…when he should have been paid Income-Related top-up all along…

http://www.dailymail.co.uk/health/article-4764722/NHS-claws-23million-unpaid-bills-fines.html

Finally, the government has got tough on fraud etc etc blah blah blah